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Discussion of Medical and Nursing Practice

Describe about the Coroners Report Analysis for Toowoomba Base Hospital.

Coroner’s report has been used to provide information about the case of Katie Lee Howman who worked as a Registered Nurse in Toowoomba Base hospital and was involved in handling critical situations in the hospital.  Based on this information, Katie knew about nursing interventions that could be used for different health conditions. The report states that Katie was married and got two young children. She died in her home while injecting herself with opioid drugs known as Fentanyl. This drug is usually used as an anesthetic to help people who are undergoing surgery to reduce the intensity of pain felt. The detection of this drug into the body of Katie was developed by a pathologist, Dr. Roger Guard. This was the only opioid detected in her body, but some other contents of drugs were detected too, which include citalopram, levetiracetam, and ibuprofen. These drugs are used as antidepressants, anticonvulsant and anti-inflammatory, showing that Katie had several problems that she needed curb, including severe pain (Jensen, 2009). Therefore, based on the doctors’ views, she had abused these drugs.

Katie was addicted to intravenous drug abuse (Fentanyl), and her death was the outcome of pathophysiological changes caused by long-term use of this drug. For instance, Fentanyl is a drug that is used as an aesthetic, and it is sometimes misused as a drug. Also, if a person uses it as a drug for a long duration, just as Katie was using, it is usually addictive, and it can force any user to use it continuously.  Further, the pathologist indicated that these drugs were reacting to the body of Mrs. Heath, thus creating crystals into her vessels. These crystals in the vessels led to the problem of blood flow into the vessels. This meant that her lungs were also straining to oxygenate the blood because there was not sufficient flow of blood into the vessels (Ballantyne, 2006). Therefore, the doctor continued to make conclusions that granuloma effect in the lungs is always an indication that there is foreign substance into the body (McAuliffe, 2016). These results showed that the presence of the drug substances was reacting with the body and they had not performed the function Katie was perceiving. After analyzing the autopsy findings, Dr. Hall stated that there was a significant number of people who had died of an opioid overdose because it is addictive as determined by National Institute of Drug Abuse (2016). After confirming that Mrs. Howman had died of Fentanyl overdose, he noted that the prevalence of people who died of the same was high and it was not a strange observation in their recent diagnosis (Aronson, 2010). This paper has been developed to create a review of Coroner’s report about the death of Katie Lee.

Documentation and Communication

Documentation and Communication

Documentation and communication regarding administration of medication play an outstanding role not only in safe medicine practice to  patients but also serve as a guiding tool to  Paramedical staff for safe medicine handling( prevents misuse of addictive drugs).  On the one hand, proper documentation ensures that the five rights of administration of medication have been addressed that is right patient, right drug, right dose, right time and right route of administration. On the other hand, illegal practices among health care members related to potentially addictive drugs are also identified and controlled by documentation and Communication.

In this context also, there was a lack of policies and procedures for safe medicine handling by health care providers. However, in order to ensure the safety of both the nurse and the patients, there should be some policies and procedures to follow. For example, in Western Australia, a code of practice for handling Schedule 8 medicine (Drug of addiction) has been launched. This practice follows The Poisons Act 1964 and Poison Regulations 1965. Actually, every effort is made to ensure safe medicine practice by staff members. Whether it is the person who prescribes medication (Medical Practitioners) or the person who administer it (Registered Nurses and Enrolled Nurses), they have to meet a set of standards (Board of Australia, 2016). For example, only authorized or registered medical practitioner can prescribe medication. Additionally, the prescription should be in the written form of organization chart along with the signature. Not only this, each location within the hospital premises supposed to have a separate register for record keeping of addictive drugs. Further, these drugs are inventoried on a monthly basis to identify and control tampering of drugs. Thereby, every hospital should follow certain policies and procedures to ensure safe medicine handling by the staff.

The ethical dilemma is a situation where Nurses and other heath practitioner find difficulty in providing ethically sound care to the patients because of some influencing factors. There are always some factors which do not let them make ethically sound decisions for improving the quality of care being given to the patient.

In this context, I found the hospital in an ethical dilemma with regard to providing efficient care to their patients. Firstly, Katie health condition was not allowing her to give appropriate care to the patients. Organisation has also found some evidence around it. For example, poor management of workload by Katie (complaint by a staff member). Additionally, one time she was not fair in Documentation with regard to patient care. She gave the medication but forget to document it. However, Documentation and communication are one of the important methods to direct or guide safe and effective patient care (Epstein and Turner, 2015).

Ethical Decision-Making

An ethical dilemma rose where the hospital had to ensure the safety (nonmaleficence) as well as the quality of care being given to the patient. At the same time, they had to address Mental and physical health issues which Katie was experiencing by respecting the autonomy (freedom to work in a suitable work environment like low care setting) principle as well.

Katie's health condition was not investigated properly. Despite being reported many times, she was working as a Critical Care Nurse who was a very demanding work for her. At the same time, patient safety was at risk.

One of the best alternatives could be Detection and control of these types of issue as early as possible with the help of strategies, such as routine dope test every 4-6 months for each employee to detect any drug addiction.

Working closely and delicately to the issue that Katie was experiencing thus providing suitable work environment (Low care) where she would not have access to Fentanyl as well as less demand by her body to take medicine. Additionally, the organization could have arranged counseling session for her to find the root cause behind drug addiction. Hence arrangement of better interventions could be possible.

The second alternative is more appropriate

AN Organisation's manager plays a very crucial role in addressing these types of issues. Attitude, feelings and understanding of the manager towards these sorts of issues found around nursing care play crucial role in determining the perspective of all another staff member.  Thus, a strong need is felt on the part of managers to be more efficient in their role as a facilitator in this type of situations. Thereby, Australian Board of Nursing and Midwifery need to understand the complexities behind the phenomenon and make policies to make sure that managers are performing well in this type of situations.

According to Kirby (1995), Advocacy is basically supporting patient’s right. Its scope range from acknowledging the patient about their rights as a patient (Patient education) to actually helping them to have the right kind of care delivered to them (Coordinating with managing authority to acknowledge any issue found in the patient care because of the negligence of another staff member). In Katie’s case, she herself was a patient, and her colleagues are supposed to take relevant actions for her.

In the mentioned scenario, neither any staff nurses nor Katie herself recognized the rights for receiving special kind of care and circumstances from managing authority. It's against the code of ethics provided by Nursing and Midwifery Board of Australia as well as the benefits mentioned in Job letter of most of the Organisation. It is promised that every employee has the right to choose suitable working arrangements in specific circumstances.  Furthermore, under special circumstances such as incompetent care, physical and mental health issues, special care is provided without any undue judgment and discrimination. Thus, an organization not only respects the right of Autonomy and respect for the patient but for its employee also. Despite this fact, Katie’s health issues have not been advocated. As a result, confusion arises on the part of organization culture which will be explained further.

State An Ethical Problem

Mrs. Howman’s medical condition was not advocated with the highest level of professionalism and care from the doctors she visited. The only step that was taken towards that issue was to prescribe drugs that were thought to reduce or curb the pain but not to cure the real issue she was suffering. Almost all the drugs that she was advised to use were addictive, and the medical practitioners did not take care of the fact the Katie was also vulnerable to the drugs, and she could be addicted. She needed a great support in dealing with the condition of severe pain that she was experiencing throughout her life. These reasons led to the misuse and overdose of the medications she thought of caring in nature.

Leadership is about supporting co-workers. It involves moving forward for helping patient, family, and Nurses to recognize and attain their rights. This aspect of managing Katie’s condition was very much similar to Advocacy where Nurses act for nurses. Nurses working with the Katie should have advocated for the safety of both patient and Nurses. Nevertheless, they report about the Katie and thereby protected patient’s safety; no one stands out for Katie’s Autonomy. This might be the reason that management did not take quick and reasonable steps to address her problem. Management only reported to APHRA for two times. The supervision and the investigation system employed for detecting substance abuse by Katy were not good as well.

The management of Katie’s condition was not up to the standards because the people who were involved in stabilizing her condition were not informed about her medical history. For instance, Dr. Phillipson was not aware of the fact that Katie was using a sterile needle to inject herself with such drugs. This fact affected the success of psychiatric treatment that the doctor was offering to Mrs. Howman after she abused the drugs in January 2010. Further, As per AHPRA’s directions, Katie supposed to undergo urine screening that determines the type of drugs that she was using. She was also supposed to be supervised to avoid illegal use of drugs in the hospital. However, in this situation the circumstances were different. When they noticed consistent screening results, they assumed that she had stopped abusing drugs. This was a wrong decision to make because she was still experiencing the hip pain, which means that she could still use the Fentanyl drugs to reduce the pain in cases where tramadol among other prescribed drugs was not functioning well. Next, Toowoomba organization had not developed a culture of developing a medical history for their employees that could assist in any situations needed.

Additional Information Collection And Analysis Of The Problem

Therefore, it can be stated that the hospital did not have effective and efficient management that could handle their employees perfectly. There was a great need of improvement on the way they handled issues affecting their employees, for example, Katie’s case.

On the basis of personal experience, organizational culture involves feelings, attitudes, understanding and most importantly perspective of managing authority for maintaining job satisfaction and mental health of the employees.  For this different method are employed  such as frequent communication between the team leader and the Nurse, policies and procedures like non-judgemental behavior towards any types of dispute or specific needs of employees, anonymous complaining system, etc. Interestingly, this helps in retaining employees too.

In this scenario, there might be a lack of communication between Katie and the senior Nurse or Team leader that prevented her problems to be addressed. Secondly, Katie's work environmental might be unsuitable for her (too much workload and physical or mental health issues would have affected her performance on the floor). However, no any concern has been shown from either colleagues or senior staff members for her miserable condition. Thus, many uncertainties arise about the organizational culture for addressing these types of issues where the organization is unable to address as well as manage the specific needs of some employees. Worth to mention here is the organizational culture role in these types of scenarios. According to Zachariadou, Zannetos, and Pavlakis (2013), sometimes it is organizational culture itself which promotes mental health issues in nursing staff because of many reasons. For example, increase the workload on employees, unfair policies of the organization which includes not concerning employees complaints such as bullying or mental torture by another staff member in the situations like drug addiction or alcoholism by staff Nurses. Consequently, organization culture has also influenced the way Katie’s case was handled.

Coroner scrutinized this issue of Katie by ensuring that every relevant information was put across thus paving the way for justice. In this case, the medical report of Katie was established that shown almost all the conditions that were related to her death. It was found that Katie had severe pains in hips that troubled her very much and she was always finding a solution to the issue. In the process of seeking medical assistance, she was prescribed to drugs that would reduce the severity of the pains, though they turned up to be addictive (Rave and Larsen, 1995). It was not within her understanding that these drugs would be addictive. Therefore, she reached a level that she could not live without the drugs, and it was observed by several people in her workplace. At some point, a nurse in the hospital observed that Katie had used the sterile needle in the washrooms though they were unsuccessful to find out the chemical contents of the syringe. The coroner also found that the Australian Health Practitioner Regulations Authority (AHPRA) had been informed about her behaviors and ordered the hospital management to observe her behaviors check out if she was abusing any drug substance (Stannard, Coupe, and Pickering, 2007).


The Coroner’s findings finally declared that Katie dies of Fentanyl’s injections that were termed as overdose and reactions according to the autopsy findings. Later after Dr. Phillipson retired from his work where he was serving Katie, the general practitioner who was left to take care of her found out that she was hardly living with opioids based on her confession. This was clear evidence that Katie was addicted and she need great medical support to help her fight the addiction. Although she has always been denying to be abusing an illicit substance, the fact that she could not live without the opioids affirmed the abuse (, 2016). The coroner also found out that the Heath was not much informed about the health condition although he knew about the pains. He had never found out that her wife was using opioid (Fentanyl) to reduce the pains she was experiencing, which was against doctor’s prescriptions (Ruzycki and Yarema, 2016). Lack of information and evidence about the misuse of opioids by Katie led to great surprise when the family and friends learned about her death.

The health organizations among other firms should understand that it is their responsibility to monitor the statuses of their employees. This will ensure that cases such as Katie’s are minimal in the society and people’s medical conditions are handled effectively. The misuse of opioids in the community needs also to be monitored to reduce the prevalence of use and protect the society from losing more people because of the same issue. Finally, it is important to inform relatives or guardians about perceived health issues, and this should also be advised by the medical practitioners to help them manage their conditions more efficiently.


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